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From the 11/12/2021 release of VAERS data:

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 185 out of 8,753

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VAERS ID: 1803999 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Injection site bruising, Injection site erythema, Injection site pain, Injection site paraesthesia, Injection site pruritus, Injection site reaction, Injection site swelling, Pruritus, Pyrexia, Rash, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Bruising at Injection Site-Medium, Site: Itching at Injection Site-Severe, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Chills-Medium, Systemic: Fever-Medium, Additional Details: pt reported today she develop a blistered like rash at the site of injection for the past 7 days after receiving vaccine and start having tingling at the injection site.


VAERS ID: 1804001 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-09
Onset:2021-10-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu
Other Medications: Cytomel, synthroid, eliquis, losartan potassium , d3,,
Current Illness: None
Preexisting Conditions: A-fib, thyroid,
Allergies: Gluten, dairy
Diagnostic Lab Data: None as of yet waiting another week to see if it subsides
CDC Split Type:

Write-up: Wednesday morning I noticed server loud pitch noise in both ears, tinnitus. I still have it over a week later though I do have short periods of low pitch ringing now


VAERS ID: 1804016 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Lethargy, Loss of personal independence in daily activities, Malaise, Nausea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within 12 hours of receiving the 2nd COVID-19 dose, Patient lost color in his face, extreme lethargy and malaise, headache, fever of 99.6 degrees, nausea, and eventual vomiting. Symptoms lasted 24 hours and caused him to remain home from school.


VAERS ID: 1804111 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-27
Onset:2021-10-13
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Ataxia, Balance disorder, Blood creatinine increased, Blood sodium decreased, COVID-19, COVID-19 pneumonia, Cerebral infarction, Chest X-ray abnormal, Chest pain, Chills, Computerised tomogram head abnormal, Cough, Dyspnoea, Epidural injection, Exposure to SARS-CoV-2, Fall, Fatigue, Fibrin D dimer increased, Gait disturbance, Head injury, Lung infiltration, Lung opacity, Muscular weakness, Myalgia, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet aspirin 81 MG chewable tablet atorvastatin (LIPITOR) 80 MG tablet citalopram (CELEXA) 40 MG tablet clopidogrel (PLAVIX) 75 MG tablet guaiFENesin (MUCINEX) 600 MG 12 hr tablet HYDROcodone-acetaminophen (
Current Illness: 10/1/2021: Pain Mgmt Appointment - Procedure: right L3 Transforaminal Epidural Steroid Injection under biplanar fluoroscopy.
Preexisting Conditions: Erectile dysfunction Insomnia Former smoker Glaucoma History of back surgery Bilateral carotid bruits Spinal stenosis of thoracolumbar region Gastroesophageal reflux disease, esophagitis presence not specified Tubular adenoma of colon Stroke Hx of angina pectoris Elevated lipids Chronic LBP Backache Arthritis
Allergies: NKDA
Diagnostic Lab Data: CT head showed interval evolution of multiple areas of infarction which were acute on his MRI in January of 2018 but no acute hemorrhage mass effect or acute infarct. Chest x-ray showed subtle areas of hazy opacities in the right upper lobe and left lower lobe which could represent early inflammatory changes secondary to COVID-19. Labs were significant for sodium of 130, creatinine of 1.23 from baseline of 0.98. Due to his recurrent falls and inability to ambulate and remained stable he was given a 500 mL bolus of IV fluids and admitted to Internal Medicine for further management.
CDC Split Type:

Write-up: Hospitalized (10.13.21 - present / still hospitalized); COVID-19 positive (10.13.21); Fully vaccinated Chief Complaint: Falls Reason for Admission: Ataxia, COVID-19 Patient is a 68 y.o. male with a past medical history of HTN, HLD, cryptogenic CVA postoperatively from back surgery in 2019 (vision changes of R eye, parethesias, dysphagia, dysarthria), carotid artery stenosis, remote 48 py smoking hx, CAD s/p CABG, GERD, depression, presenting with several days of cough and congestion as well as worsening ataxia resulting in multiple falls at home. The patient was in his usual state of health her until approximately Tuesday 10/5. He developed congestion, fatigue, myalgias, fevers and chills. He had recently been exposed to his ex-wife who is found to be COVID positive. He has been vaccinated with the Johnson & Johnson vaccine. His symptoms progressed and he developed cough and mild shortness of breath. However 3-4 days prior to admission he developed worsening bilateral lower extremity weakness and inability to maintain his balance resulting in 4-6 falls in the last 24 hours. During 1 of these falls he did hit his head. He denies any dizziness or lightheadedness but feels that he just can not maintain his balance when he is walking. No other focal numbness tingling weakness of his arms or legs. He does have a history of stroke postoperatively after his back surgery in 2019. He has a history of coronary artery disease and has had a CABG in the past. He otherwise denies headache or nuchal rigidity/neck pain. He does have mild chest pain with cough but it is not persistent and unless he is coughing. No shortness of breath at rest. His ex-wife is present at bedside and corroborates this history. Due to his worsening falls and gait he presented to the emergency department when he was found to be afebrile saturating 90-93% on room air. Progress note from 10.20.21: Acute hypoxemic respiratory failure due to COVID-19 Assessment & Plan Secondary to COVID-19 pneumonia. CT angiogram ruled out PE 10/14/2021, but did reveal infiltrates consistent with COVID-19 pneumonia. Patient had been improving, and symptoms began 10/05/2021. Over the weekend, had worsening respiratory status, now on 15 L Oxymizer. D-dimer is now elevated, previously had been normal. Proceeding with CT angiogram thorax repeat, to ensure no pulmonary embolism is developed to account for his decompensation. Continue dexamethasone and remdesivir. Completing empiric Rocephin and doxycycline. Concern for development of organizing pneumonia in the setting of COVID-19. Patient has completed remdesivir, as well as a 5 day course of empiric Rocephin and doxycycline.


VAERS ID: 1804131 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unkown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: After giving 2nd dose of Moderna Vaccine, Clerk was putting in ImmTrac System and she noticed that the vaccine had expired the day before.


VAERS ID: 1804177 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Vertigo positional
SMQs:, Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Back
Allergies: None
Diagnostic Lab Data: PCP visit on 10/20/2021
CDC Split Type:

Write-up: Benign Paroxysmal Positional Vertigo


VAERS ID: 1804178 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection related reaction, Injection site erythema, Pain in extremity, Skin sensitisation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin 40mg, moncelukasp sob 10mg, amlodipine 5mg, lisinopril, levothyroxine 5mg
Current Illness: no
Preexisting Conditions: high blood pressure
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Next morning after taking the vaccine the pain in his arm was unbearable, he couldn''t his arm it became very sore for days. At injection sight got a red spot that was sensitive to touch and a knot under it that has grew to the size of a ping pong ball.


VAERS ID: 1804237 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe and persistent headache. Started on the evening of the first dose and has persisted continuously since that time. Is not relieved with Tylenol, Ibuprofen, or Exedrine migraine.


VAERS ID: 1804266 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol-ipratropium, conc: 3-0.5mg/3mL, (DUO-NEB) Inhl nebulizer solution, albuterol HFA (PROVENTIL;VENTOLIN HFA) 90 mcg/actuation Inhl inhaler, acetaminophen (TYLENOL) 500 mg oral tablet, amiodarone (CORDARONE) 200 mg oral tablet, atorva
Current Illness: N/A
Preexisting Conditions: Type 2 diabetes, PAF, hyperlipemia, hypertension, PAD, Noonan''s syndrome, DVT, obesity, ESRD, Anemia, asthma
Allergies: Sulfa antibiotics, penicillin, tape, famciclovir
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: No adverse events, pt given pfizer for booster when their initial shots were moderna


VAERS ID: 1804269 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-28
Onset:2021-10-13
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Atelectasis, COVID-19, COVID-19 pneumonia, Chest X-ray normal, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Fatigue, Headache, Lung infiltration, Lung opacity, Pyrexia, SARS-CoV-2 test positive, Thirst
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol inhaler 2.5ml/3ml, allopurinol 100mg tablet 2x daily, amlodipine 10mg tablet daily, asprin 81mg daily, Lipitor 40mg nightly, azelastine .1% nasal spray nightly, calcitriol .25mcg capsule 2x daily, carvedilol 3.125mg tablet 2x dail
Current Illness: N/A
Preexisting Conditions: Chronic diffuse neurologic pain, obstructive sleep apnea, moderate persistent asthma, tracheobronchomalacia, acute bronchitis, basal cell carcinoma, chronic kidney disease stage IV, dermatochalasis (bilateral), diabetes type 2, gout, hyperlipidemia, hypertension, obesity, premature atrial contraction, tubular adenoma of colon.
Allergies: N/A
Diagnostic Lab Data: COVID PCR NP 10/13, positive Chest Xray 10/13 noting vasculature within normal limits, no pneumothorax or pleural effusion or cardiopulmonary disease CT chest w/o contrast 10/16 noting grandglass opacities throughout bilateral lung field compatible with COVID 19 pneumonia Chest Xray 10/21 noting increasing airspace opacities in the right midlung and right perihilar region suggesting atelectasis or infiltrate
CDC Split Type:

Write-up: Patient received first dose of Moderna COVID vaccine on 2/28/21, second dose on 3/28/21. Patient presented to reporting hospital 10/13/21 with complaint of SoB, fever, headache, dry cough since 10/9/21. Also notes fatigue, thirst. Admission PCR test administered via NP on 10/13, positive the same day. Patient currently still admitted 10/21, expected/tentative discharge listed as 10/22.


VAERS ID: 1804310 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Erythema, Hyperhidrosis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: nothing
Current Illness: none
Preexisting Conditions: none
Allergies: Gluteen intolerant, mild dairy intolerance
Diagnostic Lab Data: no additinal test were taken. We were in contact with her primary care doctor.
CDC Split Type:

Write-up: My daughter started feeling extreme dizziness and profane sweating 30s - 1 minutes. after her shot. She needed to rest in the pharmacy for 30min before they were able to leave. She had high fever for 4 days, dizziness (2 days), and redness/rash for 5 days. She is still not fully recovered.


VAERS ID: 1804325 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blister, Erythema, Headache, Hyperhidrosis, Pain, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Protonix
Current Illness: None reported
Preexisting Conditions: Hypoglycemic, migraine
Allergies: Codeine
Diagnostic Lab Data: None
CDC Split Type: PR-127-21

Write-up: Excessive sweating, fever, body ache, headache, blisters on the scalp and redness of the armpits


VAERS ID: 1804347 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient falsified DOB when registering for vaccination, stating the minor was 01/25/2009. Guardian consented to the vaccination. Local Department of Health verified with statistical records that the patients actual DOB is 01/25/2010 which made the vaccine a contraindication. No known adverse reactions noted.


VAERS ID: 1804385 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-10-13
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetic Type II - recent onset Hypothyroidism
Allergies: Erythromycin, Biaxin, Diflucan, Codeine, seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tested positive for COVID after exposure by son. Months after vaccination. Symptoms were considered mild: achy, fever, exhaustion/fatigue, nasal drainage, cough


VAERS ID: 1804414 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received an expired dose of Pfizer vaccine. Expiration 09/30/2021. Patient did not report any adverse reactions.


VAERS ID: 1804470 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Pain, Pyrexia, Tremor, Vaccination site pain
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: The first evening after the vaccine, I had strong shaking (the "chills"). In the morning I first took my temperature and had 101.6 fever which lasted all day. My arm was extremely sore at the vaccination site and whenever raising my arm and lasted over three days. I was nauseated all day and slightly nauseated the next day. my fever subsided the next day to 99.6-100. I had a slight headache.


VAERS ID: 1804484 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Dizziness, Hyperhidrosis, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Don''t Have that information
Current Illness: Don''t have that information
Preexisting Conditions: none
Allergies: No Known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s Father called to say that the child who received the vaccine started being dizzy on the day of vaccination and had to wait in the store for 30 minutes for observation. later that day, the child experienced sweating. The child also developed redish rash the next day. The child also had high temperature for 4 days. The Father reported all these to the child''s doctor who he said advised him not to allow the child to receive second dose of the vaccine.


VAERS ID: 1804606 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Moderna as primary series. Pfizer given inadvertently as booster dose.


VAERS ID: 1804716 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Eating disorder, Fatigue, Gingival pain, Mastication disorder, Noninfective gingivitis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gingival disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan
Current Illness: None
Preexisting Conditions: Hypertension Periodontal disease
Allergies: IV Contrast Dye
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Inflammation of gums causing pain and impacting ability to eat/chew. Waiting to consult with a periodontist. Symptoms have worsened in the 8 days post-vaccination Fever/chills - resolved Significant fatigue - persists


VAERS ID: 1804730 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-22
Onset:2021-10-13
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1804732 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458QA / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 524R7 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site bruising, Oedema peripheral, Swelling, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin
Current Illness: none
Preexisting Conditions: none
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flu vaccine and COVID-19 booster received on the same day, same arm (left). The following day the left side of neck down to the armpit were swollen and tender to touch. There was also bruising on the site of flu injection.


VAERS ID: 1804779 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, multi-vitamin, tylenol PRN
Current Illness: None
Preexisting Conditions: hx of Pulmonary Embolism in 2018
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client did not receive full dose of vaccination. The vial that the client received the booster dose from was inadvertently diluted a second time with saline after vial was used. Regulatory authority notified and gave recommendation to report VAER, notify client, and give recommendation to client that client received some vaccine, but not full booster dose. Due to receiving a partial dose, no further doses are recommended. 10/21/2021, 1606, client notified and given all information with good understanding verbalized.


VAERS ID: 1804848 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Hyperhidrosis, Lymphadenopathy, Nausea, Pain in extremity, SARS-CoV-2 test negative
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Asthma -albuterol HRT Estrogen/progesterone
Current Illness: RSV 1 month before
Preexisting Conditions: Asthma
Allergies: Sulfa meds
Diagnostic Lab Data: At home covid test- Negative
CDC Split Type: vsafe

Write-up: Initially extreme fatigue and sore arm Sunday and Monday. Tuesday swelling in Lymph nodes in next on left side, following day midday because nauseated, dizzy and diaphoretic. Advised to lay down and relax. Symptoms lasted two days.


VAERS ID: 1805974 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-13
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right leg shingles/zoster (L4 dermatome with rash and sensory symptoms), sensory symptoms alone extending from L4-T8 dermatomes on right.


VAERS ID: 1806165 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-16
Onset:2021-10-13
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood bicarbonate increased, Blood calcium increased, Blood lactic acid normal, Blood pressure increased, COVID-19, Chest X-ray normal, Computerised tomogram head, Computerised tomogram head normal, Computerised tomogram neck, Computerised tomogram normal, Contusion, Decreased appetite, Dysarthria, Dyspnoea, Dysstasia, Electrocardiogram normal, Fall, Fatigue, Gait disturbance, Haemoglobin normal, Hypercalcaemia, Hypophagia, International normalised ratio increased, Pollakiuria, SARS-CoV-2 test positive, Skin laceration, Somnolence, Troponin increased, Urinary incontinence, Urinary tract infection, Urine analysis abnormal, Walking aid user, Weight decreased, White blood cell count normal, X-ray limb normal
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Hypertension (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: cholecalciferol (VITAMIN D) 2000 units CAPS citalopram (CELEXA) 10 MG tablet HYDROcodone-acetaminophen (NORCO) 5-325 MG per tablet levothyroxine (SYNTHROID) 75 MCG tablet loperamide (IMODIUM) 2 MG capsule metoprolol succinate-XL (TOPROL-XL)
Current Illness: 10.4.21: Office Visit - Fatigue, falling asleep, weight loss; dyspnea 10.13.21: Being treated for a UTI; weak, fatigued, slurred speech 10.13-10.14.21 - ED to hospital admission - COVID-19 positive - admitted for weakness
Preexisting Conditions: Hospital Hypothyroidism Permanent atrial fibrillation CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min COVID-19 virus infection Generalized weakness and fall Hypercalcemia Hypertensive urgency UTI (urinary tract infection) Skin tear of right elbow, left upper arm and right side of neck Non-Hospital Cardiac pacemaker in situ HTN (hypertension) Hypercalcemia Fibrocystic disease of breast Hyperlipemia Chronic low back pain
Allergies: Benicar [Angiotensin Receptor Blockers] Codeine Contrast Dye [Ivp Dye, Iodine Containing]Hives Darvon [Aspirin] Levofloxacin Nickel Oxycodone Propoxyphene Hcl Quinidine Sulfa Drugs Tramadol HclDizziness Xarelto [Rivaroxaban]Myalgia
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized twice (10.13.21; 10.18.21); COVID-19 positive (10.13.21); fully vaccinated PRESENTING PROBLEM: COVID-19 virus infection [U07.1] COVID-19 [U07.1] 10.13.21 HOSPITAL COURSE: Patient is a 93 y.o. female who presented with weakness. PMHx of HTN, hypothyroid, Afib anticoagulated with coumadin . Patient presented with 2 week of hx progressive generalized weakness and fatigue. Denies focal weakness , numbness or tingling. Denies fall . Use walker at baseline to walk. States now with limited ability to stand or walk. She complained of decreased po intake due to loss of appetite. Recently she has been treated for a possible urinary tract infection. Patient presented at PCP office for ppm interrogation. When she returned home she was unable to stand due to too weak . In ED covid testing positive. She was not hypoxic . Calcium level elevated at 11.2 other electrolytes normal . Baseline ckd troponin elevated at 30 with delta rise of 4 . Hgb stable 13.6. ct head unremarkable, cxr wit stable chest . Patient was admitted for management of generalized weakness. She remained on room air. She did not qualify for Covid treatment. She was evaluated by PT OT and was recommended home with assist with home health and 24 hour supervision by family for atleast a week after discharge. Patient''s daughter at bedside agreed to provide the above care. She was discharged home in stable condition. 10.18.21 HISTORY OF PRESENT ILLNESS: Patient is a 93 y.o. female who presents today with weakness and fatigue. Daughter is present at the bedside. Patient was in the hospital last Wednesday overnight for fatigue and weakness that started the beginning of October. She had a UTI and was placed on antibiotics. She was struggling to get up and had a hard time on and off. She got tested at the hospital and was COVID positive but family thinks that she was having COVID even prior to her admit. She did get her COVID vaccines x 2 but did not yet get the booster. She lives at independent living at discharge. She has had children staying with her. On Saturday daughter at bedside was with her and she was up and able to walk to the bathroom. She was not eating much or drinking much. Last night her son was with her and she was up almost every hour and she had frequency and incontinence which is not normal for her. She also had a fall with her son last night around 10pm. She had a skin tear to her neck, arms and bruising on her arm and hip. She is on coumadin. She was unable to get up on her own and family is having a hard time caring for her at home so they brought her back in. Per daughter she has been more awake the last few hours than she has been all day. Daughter notes that she is not having a cough or respiratory complaints. Her oxygen has been stable the whole time per daughter. ROS and medical history reviewed with family. In the ER patient was noted to have UA that was positive she was started on rocephin and IVF. Her renal function was near baseline. She had Ca 13 up from 10.5 the other day. Her bicarb was 33 today. Initial lactic acid was 2.9. She did not meet sepsis criteria. She had normal HR, normal WBC and was afebrile. She had an INR 2.5 and Hgb 12.9. She had elevated BP in the ER but improved now though still high. Due to her fall she had extensive imaging in the ER. XR of the right elbow negative for acute fracture. CXR negative for acute process. CT cervical spine and CT head negative for acute process. EKG showed ventricular paced rhythm with LVH. She will be admitted to the hospitalist team for generalized weakness, hypercalcemia, UTI and COVID.


VAERS ID: 1806170 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-13
Onset:2021-10-13
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Chills, Chronic obstructive pulmonary disease, Condition aggravated, Fatigue, Gastrooesophageal reflux disease, Hypertension, Hypoxia, Myalgia, Productive cough, Pyrexia, SARS-CoV-2 test positive, Tachycardia, X-ray normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific dysfunction (narrow), Hypertension (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler alendronate (FOSAMAX) 70 MG tablet amLODIPine (NORVASC) 5 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet aspirin 81 MG enteric coated tablet buPROPion
Current Illness: Reported to PCP on 10.13.21 before ED: The patient has been struggling for last 3 to 4 days. Today he has 104 temperatures with myalgias and chills. Cough is significant with minimal sputum. No nausea vomiting or diarrhea. Tachycardia is present.
Preexisting Conditions: Mucopurulent chronic bronchitis Panlobular emphysema Hypoxemia COPD exacerbation GERD Hypertension Osteoporosis Paroxysmal A-Fib
Allergies: doxycycline
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (10.13.21); COVID-19 positive (10.13.21); fully vaccinated Admission Date: 10/13/2021 Discharge Date: Oct 15, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] HOSPITAL COURSE: Patient is a 68-year-old male without medical history of chronic obstructive pulmonary disease on chronic 2 L oxygen, paroxysmal atrial fibrillation, hypertension, mi BPH, GERD he presented to the hospital with acute on chronic hypoxic respiratory failure and at generalized complaints of fatigue. He patient was admitted to the hospital for an acute exacerbation of chronic obstructive pulmonary disease. He was also found to be COVID positive patient was vaccinated with Pfizer vaccine in February of 2021. Patient did have an x-ray performed in the hospital which did not reveal evidence of infiltrate. Patient was admitted to the hospital treated with dexamethasone, remdesivir. He did well with treatment. His oxygen requirement decreased back to his baseline and he was no longer having any symptoms of fevers or chills. He was feeling well enough to be discharged home. Patient was treated for elevated hypertension in the hospital he was started on Norvasc which she is to continue outpatient and follow-up with his primary care physician Discharge diagnosis: 1. Acute on chronic hypoxic respiratory failure- secondary to his underlying COPD with now acute excerebration with superimposed covid 19 infection. 2. -COVID-19 3. Hypertension accelerated 4. Paroxysmal atrial fibrillation 5. GERD


VAERS ID: 1806177 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-10-13
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Hypokalaemia, Impaired self-care, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 MG tablet amoxicillin (AMOXIL) 500 MG capsule atorvastatin (LIPITOR) 40 MG tablet cetirizine (ZYRTEC ALLERGY) 10 MG tablet DULoxetine (CYMBALTA) 30 MG delayed release capsule empagliflozin (JARDIANCE) 25 MG TABS fenof
Current Illness: NA
Preexisting Conditions: Mixed hyperlipidemia associated with type 2 diabetes mellitus Essential hypertension Atherosclerosis of native coronary artery of native heart without angina pectoris Uncontrolled type 2 diabetes mellitus with peripheral neuropathy Lymphedema of left lower extremity Snoring Morbid obesity with BMI of 40.0-44.9, adult Lung nodule Renal cyst, right Abscess of left thigh
Allergies: metformin - diarrhea sulfamethoxazole
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (10.13.21); COVID-19 positive (10.13.21); fully vaccinated Admission Date: 10/13/2021 Discharge Date: Oct 21, 2021 Discharge Disposition: home or self care Active Issues Requiring Follow-up: Acute hypoxic respiratory failure secondary to COVID-19 pneumonia Follow-up with primary care provider Patient was discharged on 2 L nasal cannula with activity, wean as able DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypokalemia [E87.6] Acute kidney injury [N17.9] Acute respiratory failure with hypoxia [J96.01] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient was admitted to the hospital with COVID-19 pneumonia. She had acute hypoxic respiratory failure needing up to 8 L nasal cannula. Patient is given remdesivir which she finished 5 days of. Patient was also on Decadron for which she finished her course as well. Patient was weaned down to room air at rest and 2 L of oxygen with activity. Patient was subsequently discharged home with supplemental oxygen to use only with activity. Patient is instructed to follow-up with her primary care doctor in the next week and determine if she can completely wean off of oxygen at that time. She also had an acute kidney injury during her stay so her lisinopril and hydrochlorothiazide were held temporarily. These were restarted the day prior to her discharge.


VAERS ID: 1806371 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunodeficiency, Interchange of vaccine products
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: She was given a Pfizer booster but she had the Moderna series (2 shots).


VAERS ID: 1807454 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: received first shot past 30-day use by date; This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (received first shot past 30-day use by date) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 019F21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (received first shot past 30-day use by date). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (received first shot past 30-day use by date) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitants were reported. No Treatment informations were reported.


VAERS ID: 1807741 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Insomnia, Pain, Renal pain
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multi-vitamin, D3 supplement, fish oil, vitamin C, Gaia Adrenal support
Current Illness: none
Preexisting Conditions: auto-immune issues; adrenal fatigue
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: rapid heart rate for two days after; difficulty sleeping. Kidneys ached afterwards. Also felt my organs in my front lower portion of body ache as well. Everything subsided by that Friday 10/15.


VAERS ID: 1807796 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-02
Onset:2021-10-13
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling, Rash, Rash erythematous, Skin ulcer
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, bee stings, benadryl
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: pain and swelling in toes and fingertips. red rash on feet and palms. Sores, and rash on head, similar to Eczema or seborrheic Dermatitis on scalp. (Both of which I have never had occur before.)


VAERS ID: 1807955 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-17
Onset:2021-10-13
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Vaccine breakthrough infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough case


VAERS ID: 1808083 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-19
Onset:2021-10-13
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Fatigue, Headache, Hypertension, Influenza virus test, Maternal exposure during breast feeding, Nausea, SARS-CoV-2 test positive, Streptococcus test
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Neonatal exposures via breast milk (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Strep, influenze and Covid tests. Covid was positive.
CDC Split Type: vsafe

Write-up: I ended up getting COVID and pre hypertension. I was diagnosed with COVID on 10/13/2021. The symptoms, headache, fatigue, nauseau, difficulty breathing. I was breastfeeding at the time and my baby had all the same symptoms. We were both diagnosed with COVID. The symptoms started a week after I got the vaccine. I wasn''t given any medications, just to rest and stay home.


VAERS ID: 1808195 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Atelectasis, Chest discomfort, Dyspnoea, Dyspnoea exertional, Imaging procedure abnormal, Impaired work ability, Lung hypoinflation, SARS-CoV-2 test negative, Somnolence
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D Vitamin C Levetiracetam 750 mg, once in morning, once at night
Current Illness: None
Preexisting Conditions: Traumatic brain injury when I was 17 and deal with memory issues on a daily basis
Allergies: Some food preservative Pineapple
Diagnostic Lab Data: Upon arriving at the hospital on 10/18/21, doctor ordered vital signs checked, blood drawn and lab work to be checked. Found COVID free. Ordered Radiology imaging, no evidence of pulmonary embolus, but found hypoinflated lungs with mild atelectasis. Provided with a volumetric exerciser and a prescription for antibiotics. The days following, I performed the volumetric exerciser, but still experience same shortness of breath each day. Some days worse than others. My PCP suggests I might need to go on an inhaler until this clears up and I can have my second corona virus vaccine shot
CDC Split Type:

Write-up: The day of the event, two hours after vaccine applied, started feeling extremely drowsy and needed to leave work. Slept most of the night, woke for two hours and went back to sleep until morning time. Following morning started experiencing shortness of breath and tightness in my chest. It made it difficult to breathe. This occurred after I simply walked 10 feet away on a flat surface. Going up and down stairs took my breathe away. The following morning I was able to breathe normally until about midday. Then, shortness of breathe occurred again. Same issue occurred every day following and stayed in constant communication with my PCP. On Monday night, he suggested I go to the ER after describing my symptoms and feeling as if I was trying to breathe under water.


VAERS ID: 1808214 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Decreased appetite, Diarrhoea, Fatigue, Headache, Pain
SMQs:, Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily Centrum, Zinc, vitamin D, Calcium
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA Allergic to some trees, mold dust and dogs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diarreah onset 10/13. Has not resolved as of 10/22. Side effects of aches, headache, tiredness, loss of taste and no appetite went away on 10/15. Called primary care physician. Left message to call me back.


VAERS ID: 1808224 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-10
Onset:2021-10-13
   Days after vaccination:276
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 10/14/21
CDC Split Type:

Write-up: SOB, hospitalization. Associate is discharged home.


VAERS ID: 1808328 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Flushing, Hyperhidrosis, Loss of consciousness, Malaise, Muscular weakness, Pain in extremity, Pallor, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: 0755 - patient became dizzy, flushed and diaphoretic in appearance and temporarily lost consciousness. BP - 123/82 HR - 106 with strong radial pulse O2 sat- 100 on RA With verbal stimulation patient became arousable and was able to state name and where she was. Once fully conscious, pt stated she felt as if her "nerve" was hit when she received her vaccine which caused severe arm pain, muscle weakness in the arm and tingling. She then stated that it felt as if her "blood vessels in her head were all becoming smaller." VS taken again - BP-120/86 HR - 103 O2 - 100 on RA Patient began feeling better & was sat up in chair, but after a few minutes sitting upright the chair, pt started to become pale and c/o "not feeling well again." We safely lowered pt back to the floor and rechecked VS. BP- 80/32 HR - 130 - O2 - 98% on RA. Pt still conscious at this time and agreeable to be transported to ED for further evaluation. Received fluids and had labs in ED, stable and dcd home same day


VAERS ID: 1808535 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-25
Onset:2021-10-13
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal distension, Abdominal pain, Abdominal pain lower, Abdominal pain upper, Anticoagulant therapy, Appendicectomy, Arthralgia, Chest pain, Computerised tomogram abdomen abnormal, Electrocardiogram normal, Myalgia, Nausea, Ovarian vein thrombosis, Pain, Pain in extremity, Painful respiration, Pollakiuria, Thrombophlebitis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Thrombophlebitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: VITAMIN C, D3, MULTIVITAMIN
Current Illness: COVID-19 9/9/2021
Preexisting Conditions: Mild hypertension-no medication required Mild gastroesophageal reflux-PRN medication
Allergies: NKA
Diagnostic Lab Data: 10/16/21-CT Scan in the ER Room, Hospital indicating Appendectomy and Ovarian Vein Blood Clot 10/17/21-Appendectomy performed 10/18/21-Started on lovenox injections for ovarian vein clot/thrombophlebitis via Dr, Hospital gynecologist
CDC Split Type:

Write-up: 10/11/21-Uncertain how pain was related to the other events, but experienced severe right deltoid/shoulder pain (in opposite arm shot was given); pain was an intense, deep ache that became severe with movement of the arm in certain positions. 10/13/21 Left upper abdominal pain, bloating and nausea occurred; right arm pain seemed to immediately and completely resolve 10/14/21-Left upper abdominal pain very gradually moved downward to middle abdomen 10/15/21-Focal area of right medial chest pain developed overnight; pain was more noticeable when lying down or breathing in moderately or deeply. Abdominal pain became more diffuse and across entire lower abdomen. Was seen by Dr; EKG was normal and no further diagnostic testing was indicated. 10/16/21-Lower abdominal pain; fullness; pressure; frequent urination continued, worsened and became more notable the lower right abdomen.


VAERS ID: 1808765 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Blood test, Electrocardiogram, Headache, Pain in extremity, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: menopause
Preexisting Conditions: menopause
Allergies: amoxicillin
Diagnostic Lab Data: ekg,blood test taken in the emergency room in the hospital,10/18/2021
CDC Split Type:

Write-up: Severe headache lasting 6 days and nights, palpitation, pain in the arm weakness


VAERS ID: 1809018 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-01
Onset:2021-10-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Blood lactate dehydrogenase, Blood test, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluticasone 50mcg Nasal Spray
Current Illness:
Preexisting Conditions: idiopathic inflammatory myopathy asthma
Allergies: none
Diagnostic Lab Data: LDH, CK, aldolase
CDC Split Type:

Write-up: muscle weakness in arms and legs


VAERS ID: 1810223 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-01-15
Onset:2021-10-13
   Days after vaccination:271
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Immunocompromised
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Got third dose from an expired vial; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Got third dose from an expired vial) in a 71-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 049E21A, 012M20A and 025L20A) for COVID-19 vaccination. Concurrent medical conditions included Immunocompromised. On 15-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 12-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to .5 ml. On 13-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to .5 ml. On 13-Oct-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (Got third dose from an expired vial). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Got third dose from an expired vial) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were provided. No treatment medications were provided. This case was linked to MOD-2021-352622, MOD-2021-352613, MOD-2021-352994, MOD-2021-352991 (Patient Link).


VAERS ID: 1810229 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-06
Onset:2021-10-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076CZ1A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site mass, Vaccination site swelling, Vaccination site warmth
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Heat (where I got the shot); Feels like a big lump (where I got the shot); Large area of swelling (where I got the shot); Pretty red (where I got the shot); This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (Heat (where I got the shot)), VACCINATION SITE MASS (Feels like a big lump (where I got the shot)), VACCINATION SITE SWELLING (Large area of swelling (where I got the shot)) and VACCINATION SITE ERYTHEMA (Pretty red (where I got the shot)) in a 27-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 076CZ1A) for COVID-19 vaccination. No Medical History information was reported. On 06-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Oct-2021, the patient experienced VACCINATION SITE WARMTH (Heat (where I got the shot)), VACCINATION SITE MASS (Feels like a big lump (where I got the shot)), VACCINATION SITE SWELLING (Large area of swelling (where I got the shot)) and VACCINATION SITE ERYTHEMA (Pretty red (where I got the shot)). At the time of the report, VACCINATION SITE WARMTH (Heat (where I got the shot)), VACCINATION SITE MASS (Feels like a big lump (where I got the shot)), VACCINATION SITE SWELLING (Large area of swelling (where I got the shot)) and VACCINATION SITE ERYTHEMA (Pretty red (where I got the shot)) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant were reported. No treatment were reported.


VAERS ID: 1810252 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-01-15
Onset:2021-10-13
   Days after vaccination:271
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Immunocompromised
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: got third dose from an expired vial; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (got third dose from an expired vial) in an 84-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 049E21A, 025L20A and 012M20A) for COVID-19 vaccination. Concurrent medical conditions included Immunocompromised. On 15-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 13-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (got third dose from an expired vial). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (got third dose from an expired vial) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant product was reported. No treatment medication was reported. This case was linked to MOD-2021-352994, MOD-2021-352991, MOD-2021-352994 (Patient Link).


VAERS ID: 1810261 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Medical history was not provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: pain in the arm; soreness in the arm; is also getting the chills; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (pain in the arm), MYALGIA (soreness in the arm) and CHILLS (is also getting the chills) in a 23-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced PAIN IN EXTREMITY (pain in the arm), MYALGIA (soreness in the arm) and CHILLS (is also getting the chills). At the time of the report, PAIN IN EXTREMITY (pain in the arm), MYALGIA (soreness in the arm) and CHILLS (is also getting the chills) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication were provided by reporter No treatment medication were provided by reporter


VAERS ID: 1810312 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Headache, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: diarrhea; sore arm; headache; at midnight they throw up; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (diarrhea), PAIN IN EXTREMITY (sore arm), HEADACHE (headache) and VOMITING (at midnight they throw up) in a 34-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 076C21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Oct-2021, the patient experienced DIARRHOEA (diarrhea), PAIN IN EXTREMITY (sore arm), HEADACHE (headache) and VOMITING (at midnight they throw up). On 14-Oct-2021, VOMITING (at midnight they throw up) had resolved. At the time of the report, DIARRHOEA (diarrhea), PAIN IN EXTREMITY (sore arm) and HEADACHE (headache) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Patient stated that they didn''t took any medication and that aren''t taking any concomitant medication. No concomitant medication was reported No treatment drug was reported.


VAERS ID: 1810359 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Unknown  
Location: Missouri  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: This spontaneous case reported by an other healthcare professional, describes the occurrence of administered expired product (expired vaccine administered beyond MFG exp. date) in a 75-year-old patient, of an unknown gender, who received mRNA-1273 (Moderna COVID-19 vaccine, batch/lot# 001C21A) for COVID-19 immunization. No medical information reported. On Oct 13, 2021, patient received a dose of mRNA-1273 (Moderna COVID-19 vaccine), unknown route; 1 dosage form. On Oct 13, 2021, patient administered expired product (expired vaccine administered beyond MFG exp. date). On Oct 13, 2021, administered expired product (expired vaccine administered beyond MFG exp. date) resolved. The reporter did not provide any causality assessments, concomitant medication or treatment information. Reporter stated this was the second dose but not sure. This case linked to MOD-2021-354610 (patient link).


VAERS ID: 1810361 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, Vaccination site pain
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Arm was sore; Expired dose; This spontaneous case was reported by an other health care professional and describes the occurrence of VACCINATION SITE PAIN (Arm was sore) and EXPIRED PRODUCT ADMINISTERED (Expired dose) in a 54-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 006C21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired dose). On an unknown date, the patient experienced VACCINATION SITE PAIN (Arm was sore). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Expired dose) had resolved. At the time of the report, VACCINATION SITE PAIN (Arm was sore) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were mentioned. No treatment details were reported.


VAERS ID: 1810384 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired vaccine beyond MFG Exp. Date administered; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond MFG Exp. Date administered) in a 56-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 001C21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond MFG Exp. Date administered). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond MFG Exp. Date administered) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication information was provided. No treatment medication were provided The reporter stated that only Lot # 001C21A was used to inject 7 people beyond the manufacturer expiration date on 13 & 14th OCT2021 (Lot# 001C21A & MFG Exp. Date: 12OCT2021). The reporter stated that she does not think that any were pregnant because of their age. The reporter also stated that she thinks that it was the second dose for all recipients but was not sure. This case was linked to MOD-2021-354610 (Patient Link).


VAERS ID: 1810394 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-06
Onset:2021-10-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Illness, Pruritus, Vaccination site pain
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OXYBUTYNIN; METHOCARBAMOL; FAMOTIDINE; ALBUTEROL [SALBUTAMOL]; OXYCODON; LOSARTAN
Current Illness: Blood pressure abnormal; Urinary tract disorder NOS
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Right arm started to itch; Pain around the injection site; Feel sick; Tired; This spontaneous case was reported by a consumer and describes the occurrence of PRURITUS (Right arm started to itch), ILLNESS (Feel sick), FATIGUE (Tired) and VACCINATION SITE PAIN (Pain around the injection site) in a 42-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047C21A) for COVID-19 vaccination. Concurrent medical conditions included Blood pressure abnormal and Urinary tract disorder NOS. Concomitant products included LOSARTAN for Blood pressure abnormal, METHOCARBAMOL for Muscle relaxant, FAMOTIDINE for Stomach discomfort, OXYBUTYNIN for Urinary tract disorder NOS, ALBUTEROL [SALBUTAMOL] and OXYCODONE HYDROCHLORIDE (OXYCODON) for an unknown indication. On 06-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced ILLNESS (Feel sick) and FATIGUE (Tired). On 15-Oct-2021, the patient experienced PRURITUS (Right arm started to itch) and VACCINATION SITE PAIN (Pain around the injection site). On 15-Oct-2021, ILLNESS (Feel sick) and FATIGUE (Tired) had resolved. At the time of the report, PRURITUS (Right arm started to itch) and VACCINATION SITE PAIN (Pain around the injection site) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Treatment medications were not provided. Concomitant medication included Albuterol which was used as a bronchodilator and Oxycodon which was used as an analgesic. Patient did not was fine for first few days.


VAERS ID: 1810423 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired vaccine beyond MFG Exp. Date administered; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond MFG Exp. Date administered) in a 68-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 001C21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond MFG Exp. Date administered). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond MFG Exp. Date administered) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant medications were provided. No treatment information was provided. Expiry date of vaccine was 12 Oct 2021. The reporter thinks it was the second dose but was not sure. This case was linked to MOD-2021-354381, MOD-2021-354454, MOD-2021-354535, MOD-2021-355209 (Patient Link).


VAERS ID: 1810436 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired vaccine beyond amnufacturer expiry date administered; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond amnufacturer expiry date administered) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 001C21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond amnufacturer expiry date administered). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond amnufacturer expiry date administered) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was reported. No treatment medication use was reported. The reporter did not think that any of the patients were pregnant because of their age. The reporter also thinks that it was the second dose for all recipients but was not sure.


VAERS ID: 1810437 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-15
Onset:2021-10-13
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Vaccination site erythema, Vaccination site swelling
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID; ELIQUIS; METFORMIN; LIPITOR
Current Illness: Dementia (taking medication for dementia); Heart disorder (taking medication for heart)
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: red spot in the arm and it is swollen; red spot in the arm and it is swollen; feeling tired; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE ERYTHEMA (red spot in the arm and it is swollen), VACCINATION SITE SWELLING (red spot in the arm and it is swollen) and FATIGUE (feeling tired) in an 80-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 011f21a, 031a21a and 002b21a) for COVID-19 vaccination. No medical history was provided by the reporter. Concurrent medical conditions included Dementia (taking medication for dementia) and Heart disorder (taking medication for heart). Concomitant products included LEVOTHYROXINE SODIUM (SYNTHROID), APIXABAN (ELIQUIS), METFORMIN and ATORVASTATIN CALCIUM (LIPITOR) for an unknown indication. On 15-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Oct-2021, the patient experienced VACCINATION SITE ERYTHEMA (red spot in the arm and it is swollen), VACCINATION SITE SWELLING (red spot in the arm and it is swollen) and FATIGUE (feeling tired). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. At the time of the report, VACCINATION SITE ERYTHEMA (red spot in the arm and it is swollen), VACCINATION SITE SWELLING (red spot in the arm and it is swollen) and FATIGUE (feeling tired) had not resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications also included medication for dementia and medication for the patient''s heart.


VAERS ID: 1810444 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired vaccine beyond manufacturer expiry date administered; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond manufacturer expiry date administered) in a 79-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 001C21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond manufacturer expiry date administered). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond manufacturer expiry date administered) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. The reporter thinks that it was the second dose for all recipients but was not sure. No relevant concomitant medications were reported. No treatment information was provided.


VAERS ID: 1810455 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-10-13
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired vaccine beyond MFG Exp. Date administered; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond MFG Exp. Date administered) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 001C21A) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond MFG Exp. Date administered). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine beyond MFG Exp. Date administered) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medication was reported. No treatment medications were reported. This case was linked to MOD-2021-354610 (Patient Link).


VAERS ID: 1810460 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Illness, Nausea, Vaccination site erythema, Vaccination site induration, Vaccination site swelling
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRAMADOL; SYNTHROID; LIPITROL [ATORVASTATIN CALCIUM]; VITAMIN D [VITAMIN D NOS]; MYRBETRIQ; ALBUTEROL HFA
Current Illness: Asthma; Immunocompromised
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: feel a little sick, and horrible.; huge red circle in her left arm, and is hard and swollen like a golf ball; huge red circle in her left arm, and is hard and swollen like a golf ball; huge red circle in her left arm, and is hard and swollen like a golf ball; nausea; headache; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (feel a little sick, and horrible.), VACCINATION SITE ERYTHEMA (huge red circle in her left arm, and is hard and swollen like a golf ball), VACCINATION SITE INDURATION (huge red circle in her left arm, and is hard and swollen like a golf ball), VACCINATION SITE SWELLING (huge red circle in her left arm, and is hard and swollen like a golf ball) and NAUSEA (nausea) in a 57-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011f21a) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Asthma and Immunocompromised. Concomitant products included TRAMADOL, LEVOTHYROXINE SODIUM (SYNTHROID), ATORVASTATIN CALCIUM (LIPITROL [ATORVASTATIN CALCIUM]), VITAMIN D [VITAMIN D NOS], MIRABEGRON (MYRBETRIQ) and SALBUTAMOL (ALBUTEROL HFA) for an unknown indication. On 13-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Oct-2021, the patient experienced ILLNESS (feel a little sick, and horrible.), VACCINATION SITE ERYTHEMA (huge red circle in her left arm, and is hard and swollen like a golf ball), VACCINATION SITE INDURATION (huge red circle in her left arm, and is hard and swollen like a golf ball), VACCINATION SITE SWELLING (huge red circle in her left arm, and is hard and swollen like a golf ball), NAUSEA (nausea) and HEADACHE (headache). At the time of the report, ILLNESS (feel a little sick, and horrible.), VACCINATION SITE ERYTHEMA (huge red circle in her left arm, and is hard and swollen like a golf ball), VACCINATION SITE INDURATION (huge red circle in her left arm, and is hard and swollen like a golf ball), VACCINATION SITE SWELLING (huge red circle in her left arm, and is hard and swollen like a golf ball), NAUSEA (nausea) and HEADACHE (headache) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. no treatment medication were reported. patient got the first dose of moderna vaccine on 15March202 with batch number 002b21a and received second dose on 12April2021 with lot number 031a21a both on her left arm. She mention that on the 13April2021 felt tired, and didn''t take anything and that symptom went away on the 14April2021.


VAERS ID: 1810468 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-18
Onset:2021-10-13
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: received an expired second dose; second dose $g35 days after first dose; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (received an expired second dose) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (second dose $g35 days after first dose) in a 49-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 007C21A and 007C21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (received an expired second dose) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (second dose $g35 days after first dose). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (received an expired second dose) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (second dose $g35 days after first dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications reported by reporter No treatment medications provided by the reporter.


VAERS ID: 1810648 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-14
Onset:2021-10-13
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 RA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy
Allergies:
Diagnostic Lab Data: Test Date: 20211014; Test Name: saliva PCR; Test Result: Positive
CDC Split Type: USPFIZER INC202101382631

Write-up: Breakthrough Covid case (positive result and symptoms); Breakthrough Covid case (positive result and symptoms); This is a spontaneous report from a contactable consumer (patient herself). A 38-years-old non pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection; Lot Number: EW0151), via intramuscular route, administered in right arm on 14Apr2021 (age at vaccination: 38-year-old) as dose 2, single for covid-19 immunization and dose 1 via intramuscular route, administered in right arm on 08Mar2021 (age at vaccination: 38-year-old) (Lot Number: EL3247) as dose 1, single for covid-19 immunization. The patient''s medical history included allergy. The patient''s concomitant medications were not reported. The vaccine was administered in a pharmacy. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine or other medications the patient received within 2 weeks of vaccination. On 13Oct2021, the patient experienced breakthrough covid case. On 14Oct2021, the patient sars-cov-2 test (saliva PCR) was positive. The patient was not hospitalized nor received any treatment for the adverse events. The patient was not diagnosed with COVID-19 prior to vaccination. The outcome of the event COVID-19 was not recovered. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1813176 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-10
Onset:2021-10-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I actually had the shot on Monday October 11 but my VaX card says 10-10-21. On Thursday I started to notice swelling around my eyes and nose. By Friday morning my eyes were EXTREMELY a swollen and the bridge of my nose was twice it?s normal size. Went to dr and they told me to take benedryl and prescribed prednisone. Today is Saturday and this morning I woke up and I?m so swollen I could barely get my contacts in. I have no other redness, itching, etc. literally just massive swollen eyes and nose.


VAERS ID: 1813244 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Catheterisation cardiac, Echocardiogram, Encephalopathy, Lumbar puncture, Stress cardiomyopathy
SMQs:, Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: synthroid, iron, statin
Current Illness: none
Preexisting Conditions: hypothyroidism, treated with synthroid
Allergies: acetominophen
Diagnostic Lab Data: echocardiogram cardiac catheterization lumbar puncture
CDC Split Type:

Write-up: presented 48 hours after booster vaccination with encephalopathy and stress/takatsubo cardiomyopathy


VAERS ID: 1813407 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-01
Onset:2021-10-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Disturbance in attention, Headache, Memory impairment, Muscle twitching, Neurological symptom
SMQs:, Dementia (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Constant headaches. Stroke like symptoms not being able to remember most everything. Can''t do mu day to day job. Trouble reading and understanding. Full body twitches.


VAERS ID: 1813568 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Brain stem thrombosis, Computerised tomogram, Coordination abnormal, Dysstasia, Fall, Gait disturbance, Hypoaesthesia, Magnetic resonance imaging head, Monoparesis
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 10/13/21 at approximately at 12:00 pm I was losing coordination of my right hand playing guitar. Then walking to bathroom tripped on right foot and fell against wall. I sat back down in chair for several hours thinking I would sleep it off. Woke up to go to bathroom and could not stand up, had no feeling or in my right arm and right leg with face numbness on right side. Called 911, they showed up and said my vitals are fine. By the time I arrived at the hospital I lost all movement on my right arm and leg. Had cat scan and several MRI a blood clot in brain stem was located. Treatment with aspirin an lovenox. Call doctor for more info. I am confident this was an adverse reaction to this vaccine.


VAERS ID: 1813641 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-10
Onset:2021-10-13
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blister, Fatigue, Headache, Herpes zoster, Pain
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: nil
Current Illness: nil
Preexisting Conditions: nil
Allergies: nil
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles: Splitting headaches Blisters Severe Body aches Fatigue


VAERS ID: 1813696 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arrhythmia, Dyspepsia, Headache, Heart rate abnormal, Heart rate increased, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific dysfunction (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalopram 20 mg Losartan 50 mg Pepsid Melatonin 10 mg Zyrtec 10mg
Current Illness: None
Preexisting Conditions: Anxiety Hypertension Gerd
Allergies: PCN
Diagnostic Lab Data: None
CDC Split Type:

Write-up: At 2 am I was awaken by a strange heart rate. I was very aware of a fast, irregular rhythm. I listened with my stethoscope and the rhythm was all over the place. I tried to take my blood pressure with our automatic machine but it just kept reading ?error?. I also had a headache and heartburn. The episode lasted about 45 min and stopped suddenly. My pulse rate and rhythm were normal again.


VAERS ID: 1813777 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301258A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Loss of personal independence in daily activities
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Have had a splitting headache every single day since I received the first dose. It''s been 12 days of having to take ibuprofen/tylenol in order to be able to function.


VAERS ID: 1814280 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-01
Onset:2021-10-13
   Days after vaccination:285
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: COVID; This spontaneous case was reported by an other health care professional and describes the occurrence of COVID-19 (COVID) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In January 2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced COVID-19 (COVID). At the time of the report, COVID-19 (COVID) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Reporter stated that symptoms were kept mild and tolerable. No concomitant medications were provided. No treatment information was provided. As patient took second dose of Moderna vaccine and experienced COVID-19 event so action taken with the drug will be Not applicable This case concerns a male patient of an unknown age with no relevant medical history who experienced non-serious unexpected event of COVID-19. The precise temporal relationship cannot be determined, having in mind that the exact vaccination date was not provided. The rechallenge was not applicable as the event occurred following the second dose of the vaccine. It was reported that the patient''s symptoms were mild and tolerable, however, detailed information regarding the clinical course of the event was not provided. Based on biological implausibility, causal relationship between the reported event COVID-19 is not applicable. The benefit-risk relationship of Spikevax is not affected by this report.; Sender''s Comments: This case concerns a male patient of an unknown age with no relevant medical history who experienced non-serious unexpected event of COVID-19. The precise temporal relationship cannot be determined, having in mind that the exact vaccination date was not provided. The rechallenge was not applicable as the event occurred following the second dose of the vaccine. It was reported that the patient''s symptoms were mild and tolerable, however, detailed information regarding the clinical course of the event was not provided. Based on biological implausibility, causal relationship between the reported event COVID-19 is not applicable. The benefit-risk relationship of Spikevax is not affected by this report.


VAERS ID: 1814285 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-06
Onset:2021-10-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Joint range of motion decreased, Neck pain, Pain, Sleep disorder, Toothache
SMQs:, Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Post vaccination: Ibuprofen 600mg ATC (q8h) for 7 days then PRN. Excedrin 2 tabs q12h prn. Home Meds: Loratidine 10mg po qhs, Montelukast 10mg po qhs, Diphenhydramine 25mg po qhs, Levothyroxine 112 mcg po qam, Allergy subligual 2 drops qam
Current Illness: None
Preexisting Conditions: Allergies
Allergies: Allergies: PCN, Latex, Bananas, all melons, peanuts, molds, grass.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 10/06/21 Received Pfizer booster injection in my left arm around 0715. Went to bed 1000 and was awaken with severe pain at 1300. The pain was severe for the first 5 days like the previous Pfizer injections. No relief with Motrin or Excedrine. At this time I still have pain and it never has gone away. It''s like a tooth ache and is much worse with movement. Around 10/13/21 I noticed loss of range of motion and strength. That also has gotten worse. Examples of pain on movement: pulling up a blanket, moving out to the side, laying on left side and reaching back. I can only move it back half-way ROM . Sleep about 2-3 hours at a time. If I roll on that side, I wake up. The pain is at the top of shoulder, outer left & right side, and between the shoulder and neck area.


VAERS ID: 1814596 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse event noted. Vaccine given outside of EUA


VAERS ID: 1814600 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse event reported. Vaccine given outside of EUA


VAERS ID: 1814608 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse event recorded.


VAERS ID: 1814636 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse reaction noted. Vaccine given outside or EUA


VAERS ID: 1814656 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-17
Onset:2021-10-13
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 10/15/21 positive covid test
CDC Split Type:

Write-up: Contracted Covid, tested positive 10/15/21


VAERS ID: 1814721 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF 2588 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Dyspnoea, Electrocardiogram, Hypoaesthesia, Oral pruritus, Skin discolouration, Swollen tongue, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Effexor 150 mg HS bupropion 150 mg niacin 500 mg famotidine 20 mg HS dorzolamide HCL opthalmic
Current Illness: pigment dispersion glaucoma degenerative disc disorder
Preexisting Conditions: see above
Allergies: clyndamiacin latanoprost
Diagnostic Lab Data: EKG blood work chest xray
CDC Split Type:

Write-up: 0730 pm itchy mouth and swelling of tongue took 20 mg prednisone, 50 mg Benadryl, 20 mg famotidine 7:50 pm short of breath, oxygen saturation at 73%, wheezing 8:00 pm numbness hands and feet, grey skin, 911 called 8:12 pm paramedics arrived, 10 L via non rebreather. Transferred to ED monitored for 5 hours/ NS given EKG normal tiponin normal chest xray negative for PE prednisone x 3 days 20 mg famotidine am AND pm Benadryl 50 mg HS Zyrtec AM itching resolved 22 October follow up


VAERS ID: 1814861 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-26
Onset:2021-10-13
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccine breakthrough infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: breakthrough case, hospitalized


VAERS ID: 1814899 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-12
Onset:2021-10-13
   Days after vaccination:274
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Malaise, Myalgia, Nasal congestion, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive Covid19 test of unknown type.
CDC Split Type:

Write-up: Complaint of elevated temperature/fever, runny nose/congestion, myalgia, and malaise


VAERS ID: 1814906 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-03
Onset:2021-10-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram cerebral normal, Anion gap decreased, Arteriogram carotid normal, Autoimmune disorder, C-reactive protein increased, CSF glucose increased, CSF protein increased, CSF red blood cell count, CSF white blood cell count, Computerised tomogram head normal, HIV test negative, Human herpes virus 6 serology negative, Lumbar puncture, Magnetic resonance imaging, Magnetic resonance imaging abnormal, Magnetic resonance imaging head abnormal, Meningitis, Mental status changes, Paraneoplastic syndrome, Perfusion brain scan normal, Pyrexia, Red blood cell sedimentation rate increased, Scan with contrast abnormal, Seizure, Toxic encephalopathy, Viral test negative, West Nile virus test negative
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Malignancy related conditions (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: On admission: CT head, CTA Head and Neck, CT Perfusion, MRI w/o contrast shows no acute abnormalities. - MRI with contrast shows subtle FLAIR signal of cerebral cortex especially in region of temporal lobes, possibly inflammation - LP (10/14): CSF studies: 153 glucose, 105 protein, 6.9 AG, 0 RBC, 5 wbc''s - CRP and ESR elevated - Meningitis/encephalitis panel negative - Solu-medrol 1g daily; 5 doses completed on 10/20/21. - switch to PO Keppra 1500mg BID for seizures - Seizure precautions - HIV, HHV6, WNV PCR - negative. - Dr. (Stroke Neurology) consulted. Appreciate recommendations: - the patient can be discharged and will follow up with Dr. in 4 weeks.
CDC Split Type:

Write-up: Unknown Brand or lot numbers of Vaccines Patient had Covid booster shot (3rd injection) on October 5th along with getting Flu vaccine as well as Shingrex at an different facility, Admitted to Hospital on 10/13/21 with Diagnosis: Principal Problem: Acute metabolic encephalopathy Active Problems: Seizure (CMS/HCC) Altered mental status Fever Neurologic: Metabolic encephalopathy, secondary meningitis vs paraneoplastic vs autoimmune vs. Seizure vs post-vaccination


VAERS ID: 1814929 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-01
Onset:2021-10-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Breast mass, Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dulera asthma inhaler; estradiol patch; Montelukast; Topiramate; Zyrtec; Allegra; Zinc; Magnesium; selenium; Calcium; Multivitamins; Lutein; Probiotic; Vitamin B Complex; Copper; Vitamin A.
Current Illness: Stomach flu.
Preexisting Conditions: Asthma; Allergies; Epstein-Barr Virus (EBV); Chronic Fatigue; Pre-menopause.
Allergies: Milk Protein Allergy.
Diagnostic Lab Data: None, upcoming appointment on 10/28/2021.
CDC Split Type: vsafe

Write-up: Lump in my right breast. Spoke with Radiologist and he stated that, a recent vaccination can swell up you lymph node. Radiologist was not surprised that this happened. I have an appointment coming up for this symptom even thought the swelling went down.


VAERS ID: 1814942 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO177 / 3 - / SYR
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: .
Current Illness: .
Preexisting Conditions: .
Allergies: .
Diagnostic Lab Data: .
CDC Split Type:

Write-up: Got the covid booster and flu shot on 10/13/2021 at 11am and by 8pm was in ER diagnosed with heart attack.


VAERS ID: 1815122 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-28
Onset:2021-10-13
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac disorder, Chest discomfort, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thiamazole, Aspirin
Current Illness:
Preexisting Conditions: High cholesterol, High blood pressure
Allergies: Pineapple
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I experienced dizziness, chest pressure, fainting and heart trouble.


VAERS ID: 1815124 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-10-13
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Burning sensation, Herpes zoster, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: prior COVID-19 infection January 18, 2021
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: Shingles diagnosis confirmed on 10/19/21 by Dr. (Dermatology).
CDC Split Type:

Write-up: 53 year old female patient developed Shingles three weeks after 2nd dose of Pfizer COVID19 vaccination. January 2021: Prior COVID19 illness. September 4, 2021: 1st COVID19 vaccine administered. September 25, 2021: 2nd COVID19 vaccine administered. Patient experienced pain in her back (left side of spine only) for 2 days, followed by burning sensation in same area, followed by rash consistent with Shingles in mid-backside left side only, extending laterally towards abdomen. Patient had chicken pox as a child in the early 1970''s. Patient also had a serious COVID19 illness in January 2021, although she was not hospitalized. Patient began treatment with Valacyclovir HCL 1 gram TID within 48 hours of developing Shingles.


VAERS ID: 1815237 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Dyspnoea, Pain, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: COVID 4 weeks prior
Preexisting Conditions: Spinal/disk problems Herniated and ruptured disk''s
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: I became short of breath, congested, body aches and all of the same issues I had when I had COVID-19. This in fact was more difficult to recover from.


VAERS ID: 1815279 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Product preparation issue, Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Client did not receive full dose of vaccination. The vial that the client received the booster dose from was inadvertently diluted a second time with saline after vial was used. Department of Public Health notified and gave recommendation to report VAERS, notify client, and give recommendation to client that client received some vaccine, but not full dose. Due to receiving a partial dose, the first dose in the series will not be re-administered. Attempted to contact client and guardian to give information on 3 separate days at multiple phone numbers with no success of reaching client or client''s guardian. 10/20/2021, 1332, 7123520377, recording stated "call cannot be completed". 10/20/2021, 1333, called 7122563425, unable to leave voicemail. 10/21/2021, 1633, 7123085308, left voicemail to return call. 10/25/2021, 1050 7123520377, recording "call cannot be completed". 10/25/2021, 1051, 7122563425, rang several times then call automatically hung up, unable to leave voicemail. 10/25/2021; 1052, left voicemail to return call.


VAERS ID: 1815464 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-01
Onset:2021-10-13
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Myalgia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR for Covid + on 10/15/2021
CDC Split Type:

Write-up: Client was vaccinated for Covid with Pfizer vaccines in February 2021. Developed symptoms on 10/13/2021: runny nose, congestion, myalgia. Tested positive for Covid with PCR on 10/15/2021.


VAERS ID: 1815697 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-06
Onset:2021-10-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiomyopathy, Chest pain, Electric shock sensation, Electrocardiogram, Immunodeficiency
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: Patient started having an electrical feeling/chest pain. She went to see her doctor and he diagnosed her with cardiomyopathy.


VAERS ID: 1816134 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-07
Onset:2021-10-13
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Heavy menstrual bleeding, Menstrual disorder
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No past medical history
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe menstrual cycle changed after first dose of Covid vaccine, including severe abdominal cramping, increased menstrual flow


VAERS ID: 1817598 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301258A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alopecia, Madarosis
SMQs:, Periorbital and eyelid disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Coreg, nexium,nexus,, vit d2, multivitamin, turmeric, calcium w d, ginko Bilbao, cetirazine
Current Illness:
Preexisting Conditions: Splenic atrophy,hypertension,cardiac arrythmia,OSA,obesity
Allergies: Gluten,pcn, clindamycin, Lipitor, mastisol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loss of scalp hair, eyelashes


VAERS ID: 1818079 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-08
Onset:2021-10-13
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chemotherapy, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Condition aggravated, Cough, Diarrhoea, Exposure to SARS-CoV-2, Hypoxia, Impaired healing, Lymphoedema, Major depression, Myeloproliferative neoplasm, Pulmonary mass, Pyrexia, SARS-CoV-2 test positive, Squamous cell carcinoma of skin, Upper respiratory tract infection, Wound
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Blood premalignant disorders (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Skin malignant tumours (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Haematological tumours of unspecified malignancy (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL 8 HOUR ARTHRITIS PAIN) 650 MG tablet acitretin (SORIATANE) 10 MG capsule alendronate (FOSAMAX) 70 MG tablet amLODIPine (NORVASC) 5 MG tablet anagrelide (AGRYLIN) 0.5 MG capsule ascorbic acid (VITAMIN C) 1000 MG tablet
Current Illness: Primary Care Office Visit - Diarrhea, unspecified type (Primary Dx); Lymphedema; Nonhealing surgical wound, initial encounter; Squamous cell carcinoma of skin; Mild episode of recurrent major depressive disorder Reports COVID-19 exposure on 9.24.21; 9.30.21: e-Visit - MPN (myeloproliferative neoplasm) (Primary Dx); Squamous cell cancer of skin of nose; Chemotherapy follow-up examination 10.9.21: Urgent Care visit - URI, abnormal X-ray - antibiotics; eventually COVID-19 PCR positive
Preexisting Conditions: Personal history of breast cancer Coronary artery disease involving native coronary artery of native heart without angina pectoris Hypercholesterolemia Severe aortic stenosis s/p TAVR Primary thrombocytosis Dizziness Anemia Arthritis Neuropathy History of TIA (transient ischemic attack) OSA (obstructive sleep apnea), severe - on CPAP Ascending aortic aneurysm Nonhealing surgical wound, initial encounter Thrombocythemia Osteoporosis, unspecified osteoporosis type, unspecified pathological fracture presence Hypothyroidism, unspecified type Infected prosthetic hip Bilateral lower extremity edema Right bundle branch block Dense breasts History of breast cancer s/p radiation therapy on the let Lymphedema Chronic diastolic heart failure Hypoxemia Lung nodule
Allergies: Hydroxyurea - rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 10.12-10.14.21; COVID-19 positive (10.9.21 and 10.13.21); fully vaccinated Admission Date: 10/12/2021 Discharge Date: Oct 14, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia COVID-19 HOSPITAL COURSE: an 86 y.o. female with history of breast cancer, severe AS status post TAVR, and primary thrombocytosis who presented with hypoxia. Patient has known COVID and was getting the monoclonal antibody when found to be hypoxic. CT showed pulmonary nodule but no evidence of COVID pneumonia. Pulmonology was consulted felt this was likely secondary to previous radiation but set her up with the lung nodule clinic. Hypoxia resolved the patient was discharged in stable condition. HISTORY OF PRESENT ILLNESS: an 86 y.o. female who presents today with complaints of covid infection. She was getting IV MAB infusion. She became hypoxic and she was brought to ER from infusion center. She denies chest pain or shortness of breath. She has some cough. No abdominal pain. She has had covid vaccine. She has had on and off fever or last month or so.


VAERS ID: 1818241 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-13
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea, Menstrual disorder
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Prior to taking the Covid-19 Janssen vaccination, I have had normal menstrual cycles since menstruation began at age 11. After receiving the shot on 10/5/ 21 menstrual cycle was expected between 10/13/2021 - 10/18/2021 and did no come. Cycle still has yet to come, even though all typical symptoms revolving around cycle have occurred (menstrual cramps, face break out, etc). There is no pregnancy, medications, or use of birth control to affect this change.


VAERS ID: 1818274 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-12
Onset:2021-10-13
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Atelectasis, Benign prostatic hyperplasia, COVID-19, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal, Condition aggravated, Cough, Diarrhoea, Dyspnoea, Headache, Hyperlipidaemia, Insomnia, Pain, Productive cough, Pulmonary fibrosis, SARS-CoV-2 test positive, Sinus disorder
SMQs:, Anaphylactic reaction (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Lipodystrophy (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler Ascorbic Acid (VITAMIN C PO) aspirin 81 MG tablet benzonatate (TESSALON) 200 MG capsule budesonide/formoterol (SYMBICORT) 160-4.5 MCG/ACT inhaler Cholecal
Current Illness: 10.13.21 - phone call to PCP - Wants COVID testing. Has HA/ST/Cough/Body hurts/Sinus/can''t sleep. has been 3 days like this.
Preexisting Conditions: COPD BPH Hearing loss Spinal stenosis of lumbar region Hypoxia Cerebrovascular accident (CVA) (HCC) Hyperlipidemia Snoring Senile osteoporosis
Allergies: NKDA
Diagnostic Lab Data: PROCEDURES 10/16/21 CT thorax: No pneumothoraces, mild chronic scarring and atelectasis 10/16/21 DR expiratory only: no evidence of pneumothorax, basilar atelectasis 10/16/21 DR chest: Questioning a small right apical pneumothorax versus adjacent osseous edge artifact. Follow-up expiratory chest x-ray recommended.
CDC Split Type:

Write-up: Hospitalized (10.16-10.19); COVID-19 positive (10.13.21); fully vaccinated Admission Date: 10/16/2021 Discharge Date: 10/19/2021 PROBLEM LIST COVID pneumonia COPD BPH HLD DETAILS OF HOSPITAL STAY: HOSPITAL COURSE an 78 y.o. male who presented with cough, shortness of breath with sputum production, diarrhea, headache who was found to be COVID 19 positive on date 10/16/21. He was treated with decadron and remdesivir, and home inhalers. He completed 4 days of remdesivir. He briefly required oxygen but was able to be weaned to room air without symptoms. He improved both clinically and in lab findings. As he remained clinically stable on RA, it was decided patient may be discharged without completion of full 5 days of remdesivir. He was discharged home in stable condition to complete decadron course.


VAERS ID: 1818328 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FM8020 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Computerised tomogram head, Dysarthria, Dysstasia, Gait inability, Laboratory test normal, Magnetic resonance imaging head, Vaccination complication
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Quinapril 5 mg Hydrochlorothiazide 12.5 mg Folic Acid 1 mg Vit D Multivitamin Ibuprophen
Current Illness: None
Preexisting Conditions: Cerebellar ataxia, hereditary. Twin brother also has it.
Allergies: None
Diagnostic Lab Data: October 14, 2021. Went to Hospital Emergency Room. Lab tests, Head CT and MRI of the head done. Results showed "no acute intracranial abnormality. Consider Covid booster adverse reaction."
CDC Split Type:

Write-up: Pt was unable to stand up from a chair; unable to walk, except for baby steps; balance worse; speech more slurred.


VAERS ID: 1818358 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-21
Onset:2021-10-13
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cycle threshold of 17.2 on 10/13/21
CDC Split Type:

Write-up: Hospitalization due to COVID 19 Reported per Janssen COVID-19 Vaccine EUA


VAERS ID: 1818619 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-04-23
Onset:2021-10-13
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0461321A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up on Oct 13th at 3am the right side of my face was paralyzed. I went to the ER thinking I was having a stroke, but the ER Dr diagnosed me with Bell''s Palsey. I then followed up with my Primary Care physician and she diagnosed me with Bell''s Palsey also. The ER dr prescribed me a steriod, and an antiviral medication.


VAERS ID: 1818665 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry skin, Oral mucosal eruption
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash appeared around patient''s mouth and nose within 24 hrs of receiving her first dose of the Moderna COVID vaccine. Patient applied topical hydrocortisone with minimal improvement. Rash resolved over the course of the following week with resulting dry, flaky skin.


VAERS ID: 1818709 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Asthenia, Back pain, Burning sensation, Chest pain, Dizziness, Erythema, Fatigue, Feeling abnormal, Injection site inflammation, Injection site pain, Injection site pruritus, Injection site warmth, Insomnia, Lymph node pain, Pain, Pain in extremity, Palpitations, Peripheral swelling, Pruritus, Rash macular, Restless legs syndrome, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: tetanus 11 or 12 years ago - achiness pneumonia vaccine 2020 - leg was being weird for a couple hours, strange, felt like stuf
Other Medications: Neurontin; Synthroid; Klonopin
Current Illness: Nasal Congestion; Headache for a week before the vaccine, allergy related
Preexisting Conditions: Fibromyalgia Thyroid Disease; Exercise Induced Asthma; Chronic Fatigue Syndrome; IBS; Osteoarthritis
Allergies: Ragweed; Mold; Dust; Possibly Strawberries; One Medication they used to wake me up after colonoscopy
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: Basically, weak and very tired and spacy, chest muscles sore, heart beating, next day had a terrible night, still achy and tired. Dizzy and tired, still achy. Trouble sleeping. Still pretty out of it and arm was getting worse. Achiness started to get worse along with fatigue. Saturday another terrible night with no sleep. Splotchy itchy red marks on arm. Saturday feeling weak and dizzy like last time, possibly lack of sleep and anxiety. 5:30pm weak and exhausted. Warmness at injection site, itch and burning sensation. Warmer than the other arm. Still inflamed. Inside of elbow on the same arm, it was red, warmer than the other side. Lymph nodes could have been it. Sunday arm was swelling and I iced it the night before. Severely exhausted, chest and back were hurting. Arm was hot again on Sunday. Forced myself to walk around and achy and burning across my back and in my legs. Bad sleep again. Tuesday- still felt terrible and leg was kicking like crazy after the vaccine (restless leg). Wednesday left arm was still warmer than the right. Thursday still very achy, went worse as the day goes on. Neurontin at night makes the pain worse during the day because the medication wore off. Thursday into Friday worst pain, almost cried. Friday afternoon, pain started again, still achy but not as bad. Tomorrow 10/27/2021 is two weeks. Achiness still comes and goes. Fatigue is better.


VAERS ID: 1818917 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Migratory Joint Pain for 2 weeks; Paresthesia for 2 weeks.


VAERS ID: 1819389 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bone pain, Chills, Dizziness, Headache, Illness, Immunodeficiency, Impaired work ability, Pain, Speech disorder, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Osteonecrosis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: I had the Rabies Series 09/19/2018 and was sick, off work 3 weeks
Other Medications: AM meds taken 6 hours before: Aspirin, Aleve, Levocetirizine, occuvite vitamin, Calcium, Estrace, Glucosamine with MSM, vitamin D3.
Current Illness: Well controlled Asthma
Preexisting Conditions: Childhood asthma, now well controlled, hyperlipidemia, menopause, insomnia
Allergies: Celebrex, Walnuts
Diagnostic Lab Data: None
CDC Split Type:

Write-up: This is my 3rd shot, my booster, required by my employer. I am a registered nurse for the past two years. I had only arm soreness with the first two vaccines, 7 hours after the booster I had significant body aches, took my routine night medications and tried to sleep, by morning had chills and rigors, thought my teeth would shatter too sick to get up for work, bone pain, body aches, dizziness when attempting to walk to the bathroom, every single bone in my body extreme pain 8/10 scale. I called in sick to the house supervisor, and he said he had a similar response. I was sick at home in severe pain two days, gradually felt better, tried to return to work and experienced manic symptoms, rushed speech, tremor, severe headaches, dizziness. We are so short staffed due to the nurses leaving who are anti-vaccine that I felt I could not leave. I continue to have headaches which are decreasing in severity daily, my strength is returning, was informed by Dr, our infectious disease specialist, that I should complete this form and notify you of my immune response to the booster. I also informed my family doctor . (See previous items)


VAERS ID: 1820973 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Immediate post-injection reaction, Immunodeficiency, Injection site cellulitis
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever from the 2nd and 3rd doses of the Pfizer vaccine. Fever also from the flu vaccine.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Tobramycin
Diagnostic Lab Data: The patient took Benadryl for the itching and has used a topical cream.
CDC Split Type:

Write-up: The patient has cellulitis on her left arm. It started out small (quarter size) immediately upon injection and has expanded to a 2 inch area on her arm after 2 days She reported today and it has not reduced in size.


VAERS ID: 1821156 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Migraine, Pallor, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Flu shot
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itch pale light-headed dizzy nose tingle migrane


VAERS ID: 1821169 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Edarbi, Rosuvastatin, Omega #, Calcium + D, Multivitamin, Co-Q-10, Biotin
Current Illness: None
Preexisting Conditions: Hypertension, Hyperlipidemia, High Risk HPV
Allergies: None
Diagnostic Lab Data: VITAMIN B12 IRON +TIBC CBC WITH DIFFERENTIAL FERRITIN TSH SEDIMENTATION RATE, AUTOMATED ANA PROTIME-INR APTT VON WILLEBRAND DISEASE PROF
CDC Split Type:

Write-up: Burst blood vessel in right big toe the day following booster vaccine. Bruising spread to second toe. Doctor described the event as a paroxysmal hematoma.


VAERS ID: 1821277 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-22
Onset:2021-10-13
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dyspnoea, Fatigue, Immunodeficiency, Malaise, Oropharyngeal pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test negative, Somnolence
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood pressure medication
Current Illness: No
Preexisting Conditions: High blood pressure, back issues
Allergies: Percocet
Diagnostic Lab Data: COVID test
CDC Split Type: vsafe

Write-up: I started feeling super tired and I had a very sore throat. I was feeling very exhausted. It went from that to just feeling unwell. I then developed a runny nose and a persistent cough. It is an unproductive dry cough I am still super tired all the time. It has gotten to a point where I find I am unable to keep my eyes open. I went to an urgent care where I took a COVID test. That was negative. I was given medication for my sore throat. I was advised to gargle with salt water but was not prescribed anything. I am currently experiencing shortness of breath as well. Though I am not sure if it is related to the vaccine. The fatigue and cough are still present. The runny nose has gotten better. I also had a low grade fever the other day though again, I am unsure is this is pertinent.


VAERS ID: 1821548 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID 19


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